Session 66 L, Value Based Approach for the Medicare Advantage Market Presenters: Julia Friedman, FSA, MAAA Matthew Kranovich, FSA, MAAA SOA Antitrust Disclaimer SOA Presentation Disclaimer
Value Based Approach for the Medicare Advantage Market Session 4-L June 13, 2017
Caveats and Limitations This presentation is intended for the sole benefit of the attendees of the 2017 SOA Health Meeting session entitled Value Based Approach for the Medicare Advantage Market as presented on June 13, 2017, and should not be distributed, in whole or in part, to any external party without the prior written permission of Milliman. We do not intend this information to benefit or create a legal liability to any third party, even if we permit the distribution of this information to such third party. This presentation is designed to highlight various forms of competitive analysis within the Medicare Advantage marketplace, as well as provide methodological suggestions for performing comparisons among plans on a rational and consistent basis. This information may not be appropriate, and should not be used, for other purposes. Julia Friedman and Matt Kranovich are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses discussed in this presentation. In preparing this information, we relied on information provided by CMS and accepted it without audit. Results and conclusions in this presentation may not be appropriate if this information is not accurate.
Agenda What is a Value Based Approach? 2017 Market Evaluation Methodology of Value Based Approach Utilizing a Value Based Approach Industry Perspective Questions 3
WHAT IS A VALUE BASED APPROACH?
What is a Value Based Approach? Collection of comprehensive market data All Medicare Advantage and Part D (MA-PD) plans offered in 2017, by county Analysis of data utilizing standardized assumptions Simplified manual bid pricing exercise Performed for all 2017 plans, in each county in which they are offered Evaluation of results Compare and contrast plan results within a county Compare and contrast plan results year over year Utilize this information to assist in planning for the upcoming year 5
What is a Value Based Approach? 2017 Overview Collection of comprehensive market data Nationwide or plan s current or future service area Analysis of data utilizing standardized assumptions Over 45,000 unique plan and county combinations nationwide in 2017 Evaluation of results More on this later! We have performed this exercise on the past 5 years of Medicare Advantage 2013 2017 years of service Market entry and exit and other plan changes from year to year are taken into account Our analysis produced over 150,000 unique year, plan, and county combinations 6
What is a Value Based Approach? Meaningful Uses Broker Education Product Development / Sales / Marketing Evaluation of Medicare Supplement Market Out-of-Pocket Cost (OOPC) versus real value Plan Finder s OOPC calculation Historical Changes in Value Added Target Population Reviews Special Needs Plans (SNP), Network, $0 premium plans Understanding Why Competitor Benefits Change Very rough proxy for Part C Rebates Understanding Enrollment Patterns 7
2017 MARKET EVALUATION
2017 Market Evaluation Results Note the following plan types are excluded from this analysis Medicare-Medicaid (Dual Demonstration) Cost Program for the All-Inclusive Care for the Elderly (PACE) Employer (800-series) plans Special Needs Plans (SNP) Nationwide Member weighted averages 9
2017 Market Evaluation Results Consistent enrollment growth of about 550,000-650,000 members per year Average Star Rating fell slightly for first time in 4 years Some large MAOs had a star rating decrease on some contracts Table 1 Market Evaluation - Star Rating 2013 2014 2015 2016 2017 Medical 3.65 3.74 3.89 3.84 3.87 Drug 3.70 3.83 3.98 4.24 4.14 Overall 3.67 3.85 3.95 4.03 3.99 10
2017 Market Evaluation Results After a nearly $2.50 increase in member premium from 2014 to 2015, average nationwide premiums have been decreasing the last few years Table 2 Market Evaluation - Member Premium 2013 2014 2015 2016 2017 Part C Premium $20.43 $19.47 $19.36 $18.91 $16.86 Part D Premium $12.46 $13.89 $16.34 $16.21 $17.38 Member Premium $32.89 $33.36 $35.70 $35.12 $34.24 11
2017 Market Evaluation Results Part C deductibles are unpopular, but more plans added it as a cost-saving measure in 2017 relative to preceding years MOOP only saw minor increases into 2017 Table 3 Market Evaluation - Deductible and MOOP 2013 2014 2015 2016 2017 Deductible $3.46 $13.32 $10.17 $10.38 $11.99 % Deductible Membership 0.6% 3.2% 2.9% 3.2% 3.3% MOOP $4,400 $4,904 $5,087 $5,262 $5,272 % $6,700 MOOP Membership 16.4% 27.2% 33.1% 38.1% 37.9% 12
What is a Value Based Approach? Total Value Added = Value of Supplemental Medical Benefits + Value of Part D Benefits + Part B Buydown Total Member Premium Results are relative rather than absolute 13
2017 Market Evaluation Results Table 4 Market Evaluation - Value Added 2013 2014 2015 2016 2017 Medical Supplemental Benefit Value $86.22 $80.88 $77.79 $74.17 $75.52 Part C Premium $20.43 $19.47 $19.36 $18.91 $16.86 Medical Value Added $65.79 $61.41 $58.42 $55.26 $58.66 Drug Supplemental Benefit Value $36.52 $34.50 $34.23 $35.95 $40.25 Part D Premium $12.46 $13.89 $16.34 $16.21 $17.38 Drug Value Added $24.06 $20.62 $17.89 $19.74 $22.87 Part B Buy-Down $1.49 $1.35 $1.22 $0.95 $0.98 Total Value Added $91.34 $83.38 $77.53 $75.95 $82.51 14
2017 Market Evaluation Results $140.00 $120.00 $100.00 $80.00 $60.00 $40.00 $20.00 Year over Year Benefit, Premium, and Value Added for Non-SNP Plans $0.00 Benefit Value Total Premium Value Added 2013 2014 2015 2016 2017 15
2017 Market Evaluation Results Medical value added has declined steadily over the years Drug value added was declining for past few years; uptick in 2017 Uptick in both benefit value and value added in 2017 Part C premium decreasing, Part D premium increasing Part B buy-down less and less popular 16
2017 Market Evaluation Results Two National Competitors Table 5 Market Evaluation - Value Added of Two National Competitors 2013 2014 2015 2016 2017 Competitor #1 Total Member Premium $32.66 $31.65 $30.13 $32.15 $31.22 Total Membership Growth N/A 14.8% 14.6% 4.5% 1.0% Medical Value Added $65.01 $65.84 $68.99 $58.70 $57.03 Drug Value Added $24.76 $20.02 $18.36 $17.17 $21.03 Total Value Added $91.63 $88.27 $89.80 $78.33 $80.62 Competitor #2 Total Member Premium $5.61 $6.21 $16.47 $16.36 $16.03 Total Membership Growth N/A -1.7% -1.2% 8.3% 12.9% Medical Value Added $70.10 $66.96 $55.69 $56.08 $66.93 Drug Value Added $35.62 $31.80 $19.09 $26.73 $28.74 Total Value Added $106.53 $98.93 $74.90 $82.81 $95.67 17
2017 Market Evaluation Results Two National Competitors Comparison of Two National Competitors $120.00 $100.00 $80.00 $60.00 $40.00 $20.00 $0.00 2013 2014 2015 2016 2017 Competitor #1-Value Added Competitor #2-Value Added Competitor #1-Membership Change Competitor #2-Membership Change 16.00% 14.00% 12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00% -2.00% -4.00% 18
2017 Market Evaluation Results Inpatient cost sharing consistently increasing SNF also increasing, with some ups and downs Table 6 Market Evaluation - Part A Benefits - Total Member Cost per Stay 2013 2014 2015 2016 2017 Inpatient (Medical / Surgical) $707 $786 $853 $895 $918 Inpatient (Mental Health) $679 $739 $807 $841 $889 Skilled Nursing Facility $1,343 $1,387 $1,338 $1,414 $1,440 19
2017 Market Evaluation Results Copays are more popular than coinsurance Coinsurance hit the max in 2017 for both PCP and Specialist Specialist cost sharing has increased year over year Table 7 Market Evaluation - Part B Benefits - Physician Cost Sharing 2013 2014 2015 2016 2017 Primary - Copay $9.60 $10.14 $10.00 $9.17 $8.70 Primary - Coinsurance 17.3% 18.3% 17.0% 19.2% 20.0% % Copay Membership 99.8% 99.8% 99.5% 99.6% 99.8% Specialist - Copay $29.20 $32.23 $33.95 $34.76 $35.24 Specialist - Coinsurance 19.3% 19.5% 19.7% 20.0% 20.0% % Copay Membership 99.8% 99.7% 99.5% 99.5% 99.6% 20
2017 Market Evaluation Results Part D Deductibles have increased in popularity since 2015 Few plans adjust the ICL, so average is close to the standard ICL each year Trend towards lower cost sharing on Tier 1 generics and Tier 5 specialty Table 8 Market Evaluation - Part D 2013 2014 2015 2016 2017 Deductible $17.98 $24.97 $96.28 $126.98 $130.11 % Deductible Membership 10.4% 13.4% 41.1% 48.7% 51.6% Initial Coverage Limit $3,068 $2,921 $3,020 $3,329 $3,705 Members with MA-PD Coverage 9,339,072 9,983,675 10,662,947 11,337,793 11,913,842 Average Retail 30-Day Tier 1 Copay $3.70 $3.67 $3.14 $3.23 $2.97 Average Retail 30-Day Tier 5 Coinsurance 31.8% 31.7% 31.1% 29.5% 29.9% 21
2017 Market Evaluation Results Dental benefits have risen in popularity Table 9A Market Evaluation - Enticement Benefits - Dental 2013 2014 2015 2016 2017 Preventive Dental Limit $776.31 $705.62 $705.91 $671.09 $651.94 Members 4,007,906 4,137,729 5,346,768 6,204,191 6,899,070 Comprehensive Dental Limit $1,116.96 $1,020.11 $972.59 $1,085.85 $1,065.96 Members 2,057,391 2,200,476 2,711,207 3,039,031 3,414,529 22
2017 Market Evaluation Results Vision benefits are one of the most popular enticement benefits in MA Table 9B Market Evaluation - Enticement Benefits - Vision 2013 2014 2015 2016 2017 Vision Exam Copay $14.32 $16.33 $13.86 $14.09 $9.99 Coinsurance 44.2% 20.0% 20.0% 20.0% 20.0% Members 8,808,605 8,956,998 10,199,758 10,941,982 11,440,845 Vision Hardware Limit $81.37 $77.91 $88.73 $91.51 $97.19 Members 5,452,075 5,645,373 6,660,938 7,539,921 7,854,778 23
2017 Market Evaluation Results Hearing benefit offerings increased dramatically in 2016 Table 9C Market Evaluation - Enticement Benefits - Hearing 2013 2014 2015 2016 2017 Hearing Exam Copay $13.19 $14.58 $13.12 $11.38 $11.65 Coinsurance N/A N/A N/A N/A N/A Members 6,012,459 6,113,446 6,845,713 8,222,960 9,257,389 Hearing Hardware Limit $472.80 $442.30 $561.97 $531.60 $749.61 Members 4,367,568 4,171,397 4,884,529 5,680,010 7,107,555 24
METHODOLOGY OF A VALUE BASED APPROACH
Methodology Data Collection cms.gov All data are contained in the Public Use Files (PUFs) County-specific MA-PD Enrollment https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and- Reports/MCRAdvPartDEnrolData/Monthly-Enrollment-by-Contract-Plan-State-County.html Member Premium https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/ Star Ratings https://www.cms.gov/medicare/prescription-drug-coverage/prescriptiondrugcovgenin/performancedata.html SAS Plan Benefit Package (PBP) databases https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and- Reports/MCRAdvPartDEnrolData/Benefits-Data.html 26
Methodology Analysis Objective: Efficiently calculate a manual rate bid development for all MA-PD plan and county combinations relevant to the organization Part C pricing model that adjusts for the following at the county level: Area (unit cost and utilization differences) Risk score FFS Risk Rate (published by CMS) Part D pricing model Targeting a defined standard nationwide bid Adjusts for Risk Score Formulary PDP Region 27
Methodology Analysis Part C Part C Deductible Out-of-Pocket Maximum (MOOP) Inpatient Medical / Surgical (varying with days) Inpatient Mental Health (varying with days) Skilled Nursing Facility (varying with days) Emergency Care Urgent Care Home Health Care Medicare Professional Services Primary Care Physician Specialty Care Physician Mental Health Dental Vision Hardware Exams Hearing Podiatry Chiropractor Laboratory Radiology X-Ray Tests & Procedures Therapeutic Radiology Diagnostic Radiology Outpatient Services Surgery Ambulatory Surgical Center Substance Abuse Therapy Physical / Speech Occupational Therapy Ambulance Durable Medical Equipment / Prosthetics / Supplies Diabetic Coverage Monitoring Self-Management Training Therapeutic Shoes / Inserts Part B Rx Enticement Benefits Preventive Dental Comprehensive Dental Vision Hardware Exams Hearing Hardware Exams Non-Emergency Transport Non-Medicare Covered Podiatry Non-Medicare Covered Chiropractic Acupuncture Over-the-Counter Drug Card Meals Worldwide ER Coverage Supplemental Chapter 4 Benefits, for example Fitness Benefit Health Education Nutritional / Dietary benefit Smoking and Tobacco Cessation Counseling 28
Methodology Analysis Part C A = WK4 H108 Total Revenue Requirement: Total Benefits Net PMPM Total Cost for standardized MA-PD plan to provide all offered benefits B = WK4 O108 Total Revenue Requirement: Medicare Covered Net PMPM Total Cost for standardized MA-PD plan to provide only FFS benefits C = Value of Supplemental Medical Benefits = A - B Value to member of Part C benefits, not accounting for member premium 29
Methodology Analysis Part C C = Value of Supplemental Medical Benefits D = Part C Member Premium E = C D = Part C Value Added Part C Value Added = Value of Supplemental Medical Benefits Part C Member Premium Measurement of value of Part C benefits to member, above and beyond traditional Medicare Captures value of both additional benefits and premium allocated to Part C Allows a high level understanding of how beneficial Part C portion of benefits is to member 30
Methodology Analysis Part D Part D Deductible Including / Excluding Tiers Initial Coverage Limit Retail Cost Sharing (excluding non-preferred) Mail Cost Sharing Gap Coverage by Tier Supplemental Drug Coverage Formulary This file must be purchased from CMS 31
Methodology Analysis Part D F = WK7 F21 + F25 = Rounded Part D Premium for Basic and Supplemental portions of the Part D Benefit Prior to A/B rebate allocation Total Cost for standardized MA-PD plan to provide all offered benefits, less direct subsidy In other words, the member premium to obtain all offered benefits 32
Methodology Analysis Part D F = Member Premium needed to offer proposed benefits G = Actual Part D Member Premium (Basic + Supplemental) H = F G = Part D Value Added Part D Value Added = Value of Part D Benefit (basic + supplemental) Part D Member Premium Measurement of value of Part D benefits to member Allows a high level understanding of how beneficial pharmacy benefits are to member 33
Methodology Analysis I = Part B Buydown (off-setting, a reduction to a members Part B premium) J = C + F + I (D + G)= Total Value Added Or, to go back to basics Total Value Added = Value of Supplemental Medical Benefits + Value of Part D Benefits + Part B Buydown Total Member Premium 34
Methodology Evaluation Results are relative rather than absolute Results can only be compared within a county Calibration to estimated FFS 2017 costs and standard FFS benefit are at a county level Results should be considered a very rough proxy for plan rebates Certainly not exact, considering standardized nature of this pricing exercise Estimates created in prior years will not match current year estimates Due to changing pricing parameters However it is appropriate to compare different year results within one year s analysis Only difference should be in the plan s benefits and premium 35
Meaningful Uses Broker Education Product Development / Sales / Marketing Evaluation of Medicare Supplement Market Out-of-Pocket Cost (OOPC) versus real value Plan Finder s OOPC calculation Historical Changes in Value Added Target Population Reviews Special Needs Plans (SNP), Network, $0 premium plans Understanding Why Competitor Benefits Change Very rough proxy for Rebates Understanding Enrollment Patterns 36
UTILIZING A VALUE BASED APPROACH INDUSTRY PERSPECTIVE
Agenda Quick analysis using Plan Finder Used to change AEP marketing emphasis and spend Done for each county in service area Short term analysis Used to determine relative position for membership forecasting Quantitative or subjective approach Detailed analysis using the Value Based approach Used to determine product design, market exits/expansions, refinement of membership, financial forecasting for upcoming year Combination of AEP sales vs. forecast, full benefit comparison of all counties in each PBP, and determination of competitive advantages/disadvantages at a benefit level 38
Plan Finder Data Quick and easy Plan Finder debuts in early October for upcoming AEP Zip code for each county you want data for Plan Finder will show all HMO, PPO, and SNP competitors in each county Ranking based on CMS valuation of OOPC Add additional scenarios by adding medications to search Low, medium, high cost drugs can be used to determine if product is attracting the members your company wants Analysis allows you to evaluate positioning of your products Based on analysis, can quickly change advertising strategy and/or sales resources Deploy to where products are positioned well, remove from markets with poor positioning If multiple products in one market, can quickly change resources to focus on leading product 39
Short Term Analysis Still uses Plan Finder data Only key benefits are shown on Plan Finder, summarize these at high level Premium Deductible / Maximum Out-of-Pocket Inpatient Cost Sharing Skilled Nursing Facility (SNF) Outpatient Hospital Physician (PCP) cost sharing Specialist cost sharing Are Hearing, Vision, and Dental offered with this plan? Pharmacy (requires more in depth analysis than simple Plan Finder search) Attempt quantitative analysis by assigning value to benefit and where plan falls compared to competitors. 40
Short Term Analysis Company 1 Company 2 Company 3 Company 4 Company 5 Company 6 Premium $0 $0 $19 $29 $39 $49 Inpatient $300 Days 1-5 $100 Days 1-5 $100 Days 1-4 $200 Days 1-4 $200 Days 1-5 $250 Days 1-8 PCP $0 $5 $0 $15 $10 $20 Specialist $20 $15 $10 $40 $20 $40 Rx $0/$0/$45/$95/33% $0/$5/$45/$95/33% $0/$0/$5/$10/30% $0/$0/$40/$90/30% $0/$5/$45/$95/30% $0/$0/$5/$10/33% Dental C - no cost share C - cost sharing N/A C - no cost share C - cost sharing N/A Vision C - no cost share N/A N/A C - cost sharing C - no cost share C - cost sharing Hearing C - no cost share N/A N/A C - cost sharing C - cost sharing C - no cost share Company 1 Company 2 Company 3 Company 4 Company 5 Company 6 Premium 7.5 7.5 5.0 5.0 2.5 2.5 Inpatient 2.0 6.0 6.0 4.0 4.0 2.0 PCP 6.0 4.0 6.0 2.0 4.0 2.0 Specialist 4.0 6.0 6.0 2.0 4.0 2.0 Rx 4.0 2.0 6.0 4.0 2.0 6.0 Dental 3.0 2.0 1.0 3.0 2.0 1.0 Vision 3.0 1.0 1.0 2.0 3.0 2.0 Hearing 3.0 1.0 1.0 2.0 2.0 3.0 Total 32.5 29.5 32.0 24.0 23.5 20.5 Scoring Top 1/3 of Plans = 3 Middle 1/3 of Plans = 2 Bottom 1/3 of Plans = 1 Premium x 2.5 IP, PCP, Specialist, Rx x 2 Dental, Vision, Hearing x 1 41
Detailed Analysis Used to Determine Changes to where you will spend advertising dollars Changes to what product or benefit features are highlighted in advertising Changes to where you devote sales resources Changes to AEP membership forecast Changes to next years membership and financial forecasts Changes to next years benefit design If you want to stay in the market, reduce or expand geographic footprint Considerations of what the benefit plan will need to look like to compete This is an example of the Value Added analysis 42
Detailed Analysis Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Star Ratings 2017 Overall Star Plan Rating (Used in 2018 Bids) 4.0 4.5 3.5 4.5 2017 Medical Star Rating 4.0 4.5 3.0 4.5 2017 Drug Star Rating 3.5 4.0 4.0 5.0 Premium (Part C plus Part D) 2017 Member Premium $0.00 $0.00 $0.00 $0.00 Estimated Value Added by Year 2017 Total Value Added $180.82 $151.03 $134.63 $131.83 2017 Estimated Value Added Medical Supplemental Benefit Value Inpatient / SNF / Home Health Supplemental Benefit Value $15.35 $8.79 $12.25 $14.67 Outpatient Supplemental Benefit Value $16.84 $13.14 $6.67 $12.37 Professional Supplemental Benefit Value $44.26 $36.31 $27.91 $39.70 Other Medicare Covered Supplemental Benefit Value $4.34 $7.40 $6.05 $7.75 Other Non-Medicare Covered Supplemental Benefit Value $47.63 $22.39 $38.65 $20.54 Part C Value Added $128.42 $88.03 $91.53 $95.03 Part D Value Added $52.40 $63.00 $43.10 $36.80 2017 Total Value Added $180.82 $151.03 $134.63 $131.83 Rank by Total Value Added 1 2 3 4 43
Detailed Analysis Part C Benefits Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Deductible $0 $0 $0 $0 Out-of-Pocket Maximum $6,700 $6,700 $6,500 $4,900 Inpatient Medical / $175/Day for Days 1-6 & $300/Day for Days 1-6 & $225/Day for Days 1-7 & $225/Day for Days 1-7 & Surgical $0/Day for Days 7-90 $0/Day for Days 7-90 $0/Day for Days 8-90 $0/Day for Days 8-90 Inpatient Mental Health Skilled Nursing Facility $175/Day for Days 1-6 & $0/Day for Days 7-90 $0/Day for Days 1-20 & $150/Day for Days 21-100 $395/Day for Days 1-4 & $0/Day for Days 5-90 $0/Day for Days 1-20 & $160/Day for Days 21-100 $300/Day for Days 1-5 & $0/Day for Days 6-90 $225/Day for Days 1-7 & $0/Day for Days 8-90 $0/Day for Days 1-20 & $0/Day for Days 1-20 & $160/Day for Days 21-51 $164.50/Day for Days 21- & $0/Day for Days 52-100 100 Emergency Room $75 copay $75 copay $75 copay $75 copay Urgent Care $0-$20 copay $40 copay $10-$65 copay $25-$40 copay Home Health $0 copay $0 copay $0 copay $0 copay Primary Care Physician $0 copay $0 copay $0 copay $0 copay Specialty Care Physician $20 copay $40 copay $45 copay $25 copay Professional Mental Health $20 copay $40 copay $40 copay $30-$40 copay Laboratory $0-$100 copay $0-$75 copay $0-$50 copay $0 copay X-Ray $0-$50 copay $0-$75 copay $50-$325 copay $0 copay Tests & Procedures $0-$100 copay $25-$150 copay $0-$50 copay 20% coinsurance Therapeutic Radiology $20-$50 copay 20% coinsurance 20% coinsurance 20% coinsurance Diagnostic Radiology $20-$100 copay $50-$150 copay $250-$325 copay 20% coinsurance OP Surgery $150 copay $200 copay $325 copay $200 copay Ambulatory Surgical Center $75 copay $100 copay $250 copay $200 copay OP Mental Health $20 copay $40 copay $40 copay $30-$40 copay Substance Abuse $20-$100 copay $150-$250 copay $40 copay $30-$40 copay Therapy - Physical / Speech $0-$40 copay $25-$40 copay $35-$40 copay $25 copay Occupational Therapy $0-$40 copay $25-$40 copay $35-$40 copay $25 copay Ambulance $265 copay $200 copay $225 copay $150 copay Durable Medical Equipment 0%-20% coinsurance $0 copay 0%-20% coinsurance 20% coinsurance Part B Rx 20% coinsurance 20% coinsurance 20% coinsurance 20% coinsurance 44
Detailed Analysis Part D Benefits Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Part D Benefit Type Enhanced Alternative Enhanced Alternative Enhanced Alternative Enhanced Alternative Deductible $0 $0 $0 $220 Initial Coverage Limit $3,700 $3,700 $3,700 $3,700 Deductible By Tier No Deductible No Deductible No Deductible T3 / T4 / T5 30 Day Retail Scripts - Tier 1 $0 $0 $5 $2 30 Day Retail Scripts - Tier 2 $10 $0 $13 $8 30 Day Retail Scripts - Tier 3 $40 $47 $40 $45 30 Day Retail Scripts - Tier 4 $89 $100 $93 $95 30 Day Retail Scripts - Tier 5 33% 33% 33% 28% 90 Day Mail Scripts - Tier 1 $0 $0 $15 $0 90 Day Mail Scripts - Tier 2 $0 $0 $39 $0 90 Day Mail Scripts - Tier 3 $110 $141 $12 $125 90 Day Mail Scripts - Tier 4 $257 $300 $279 $275 90 Day Mail Scripts - Tier 5 33% 33% 33% 28% Gap Coverage by Tier All / All / Some / Some / Some All / All / None / None / None All / None / None / None / None None / None / None / None / None Supplemental Drug Coverage NC C NC NC 45
Detailed Analysis Enticement Benefits Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Preventive Dental Cost Sharing $0 copay $0 copay $0 copay $0 copay Dental Limit No Limit No Limit No Limit No Limit Dental Limit Period N/A N/A N/A N/A X-Rays C C C C Oral Exams C C C C Prophylaxis (Cleaning) C C C C Fluoride Treatment NC NC NC NC Comprehensive Dental Cost Sharing $0 copay $0-$535 copay $0 copay NC Dental Limit No Limit No Limit No Limit NC Dental Limit Period N/A N/A N/A NC Prosthodontics, Other Oral / Maxillofacial Surgery NC C C NC Vision Non-Routine Services NC C NC NC Diagnostic Services NC C NC NC Restorative Services C C NC NC Endodontics / Periodontics / Extractions C C C NC Exams $0 copay $0 copay $0 copay $0 copay Hardware $0 copay $0 copay $250 copay NC Hardware Limit $180 Limit $100 Limit $100 Limit NC Hardware Limit Period Every Year Every Year Every Year NC 46
Detailed Analysis Enticement Benefits (continued) Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Hearing Exams $0 copay $0 copay $45 copay $0 copay Hearing Aids $0 copay $0 copay $999 copay $380 copay Hearing Aid Limit $500 Limit $500 Limit No Limit No Limit Hearing Aid Period Every Year Every Year N/A N/A Non-Emergency Medical Transport Cost Sharing $0 copay NC NC NC Number of One-Way Trips 50 NC NC NC Over-the-Counter Drug Card OTC Drug Card Limit $30 Limit NC NC NC OTC Drug Card Period Every Month NC NC NC Worldwide ER Cost Sharing $75 copay $75 copay $125 copay $75 copay Limit No Limit $50,000 Limit No Limit No Limit 47
Detailed Analysis Enticement Benefits (continued) Competitor Plans Plan #1 Plan #2 Plan #3 Plan #4 Health Education C C C NC Nutritional / Dietary Benefit NC NC NC NC Smoking and Tobacco Cessation Counseling C C NC NC Fitness Benefit C C C C Remote Access Technology C C NC C Telemonitoring Services NC NC NC NC Enhanced Disease Management NC NC NC NC Bathroom Safety Devices NC NC NC NC Counseling Services C C NC NC In-Home Safety Assessment NC NC NC NC Personal Emergency Response System (PERS) NC NC NC NC Medical Nutrition Therapy (MNT) NC NC NC NC Post Discharge In-Home Medication Reconciliation NC NC NC NC Re-Admission Prevention NC NC NC NC Wigs for Hair Loss Related to Chemotherapy NC NC NC NC Weight Management Programs NC NC NC NC Alternative Therapies NC NC NC NC 48
Questions?
Provide your feedback and win! Complete your evaluation and be entered to win one of these three great prizes: One complimentary registration to the 2018 Health Meeting One complimentary room reservation in a standard room (max. 3 nights) at the Austin Hilton for the 2018 Health Meeting One complimentary registration to a Health Section sponsored webcast
Julia Friedman, FSA, MAAA Actuary, Milliman julia.friedman@milliman.com Matt Kranovich, FSA, MAAA Consulting Actuary, Milliman matt.kranovich@milliman.com
Thank you!